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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700105
Report Date: 08/12/2022
Date Signed: 08/12/2022 11:28:49 AM

Document Has Been Signed on 08/12/2022 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197700105
ADMINISTRATOR:MARTINEZ, VIRGINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 939-1869
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
08/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Virginia MartinezTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPA), Isabel Ortega conducted a Case Management Other inspection for the purpose of reviewing the conditions set forth during the Non- compliance meeting held at the Palmdale Regional Office. Licensee was placed on required inspections effective 6/22/2022. LPA announced the purpose of the inspection and was granted entry by Licensee. A tour of the facility was conducted. LPA Ortega observed 4 children in care and engaged in free play.

Licensee is on required and purpose of inspection is to assure child's safety, personal rights and Title 22 regulations are being met. LPA observed four children in care, two toddlers, one school age and one infant. Infant safe log has been implemented(LPA observed 15 minute log in place). Children's napping location is visible and in an open area. Licensee's CPR/First aid is current, expires 10/19/2023. Mandated reporter training is current.


Licensee has met Title 22 regulations, no deficiencies will be cited today.
An exit interview was conducted, and a copy of this report, appeal and notice of site visit was provided to Licensee on this day. All Licensing reports are recommended to be kept on file for minimum three years.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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